Desai Amita, Aucott Susan, Frank Karen, Silbert-Flagg JoAnne
Neonatology, The Johns Hopkins Hospital (Drs Desai and Aucott), and; Johns Hopkins University School of Nursing (Drs Frank and Silbert-Flagg), Baltimore, Maryland.
Adv Neonatal Care. 2018 Aug;18(4):260-266. doi: 10.1097/ANC.0000000000000521.
Proper assessment of pain is essential to allow for safe and compassionate care of infants in the neonatal intensive care unit (NICU). The Neonatal Infant Pain Scale (NIPS) used in an urban level IV NICU addresses acute pain but may not adequately measure chronic neonatal pain.
The purpose of this quality improvement study was to improve acute and chronic pain measurements for neonates in an NICU through implementation of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS).
METHODS/SEARCH STRATEGY: An evidence search for a comprehensive tool to assess neonatal pain in the setting of a 45-bed level IV NICU was completed. The N-PASS was found to be inclusive of measuring acute and chronic neonatal pain. Participants for a quality improvement study, including NICU nurses and providers, were educated on the N-PASS. Nurses documented in the N-PASS and the NIPS during routine pain assessments for NICU infants for comparison. Participants completed a survey assessing knowledge of the N-PASS.
FINDINGS/RESULTS: When compared, the N-PASS generated 98% of pain scores greater than the NIPS. Surveys demonstrated an increase in staff knowledge for the N-PASS.
Implementation of a multidimensional pain tool that measures acute and chronic pain is essential for proper pain assessment. Providers can manage neonatal pain when accurate documentation is available.
Further research evaluating guided management of acute and chronic pain scores on the N-PASS would aid hospital policies on therapies for neonatal pain.
准确评估疼痛对于在新生儿重症监护病房(NICU)安全且富有同情心地照顾婴儿至关重要。一家城市四级 NICU 使用的新生儿疼痛量表(NIPS)可解决急性疼痛问题,但可能无法充分衡量新生儿慢性疼痛。
本质量改进研究的目的是通过实施新生儿疼痛、躁动和镇静量表(N-PASS)来改善 NICU 中新生儿急性和慢性疼痛的测量。
方法/搜索策略:完成了一项证据搜索,以寻找一种用于在拥有 45 张床位的四级 NICU 环境中评估新生儿疼痛的综合工具。发现 N-PASS 涵盖了测量新生儿急性和慢性疼痛。包括 NICU 护士和医护人员在内的质量改进研究参与者接受了 N-PASS 的培训。护士在对 NICU 婴儿进行常规疼痛评估时记录 N-PASS 和 NIPS 的数据以供比较。参与者完成了一项评估对 N-PASS 知识了解程度的调查。
相比之下,N-PASS 产生的疼痛评分比 NIPS 高的情况占 98%。调查显示工作人员对 N-PASS 的知识有所增加。
实施一种能测量急性和慢性疼痛的多维疼痛工具对于准确的疼痛评估至关重要。当有准确记录时,医护人员可以更好地管理新生儿疼痛。
进一步研究评估 N-PASS 上急性和慢性疼痛评分的指导性管理,将有助于制定医院关于新生儿疼痛治疗的政策。